Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Objectives
• What is ESR?
• Explain the principle of erythrocyte
sedimentation.
• Discuss mechanism of ESR?
• What are the...
ESR
• Erythrocyte- red cell
• Sedimentation- settling
• Rate- amount in a given
time
Introduction
• Also k/a ‘sed’ rate
• Non specific test indicative of inflammation
• It is used as an initial screening too...
• Inexpensive making it
widely used screening test
• Measure- how much red cell
will settle in a given time
• Unit-measure...
Principle
When the anti coagulated blood is allowed to
stand vertically, the red cells will settle towards
the bottom of t...
Mechanism
• ESR is determined by the interaction between
factors that promote (fibrinogen) and resist
(negative charge of ...
Mechanism
• Plasma proteins, especially
fibrinogen, adhere to the red cell
membranes and neutralize the
surface negative c...
Stages
• Stage of rouleaux formation/aggregation- 10
min
• Stage of sedimentation/settling- 40 min
• Stage of packing- 10m...
Factors affecting ESR
Physiological factors
• Plasma factors
• Red cell factors
• Rouleaux formation
• Age
• Sex
• Pregnan...
Plasma factors
• Fibrinogen, globulin and cholesterol increase
ESR by decreasing negative charge of RBC.
Negative charge p...
Red cell factor
• Number:
– Increased in red cell mass- decrease ESR
– Decreased red cell mass- increased in ESR
• Size:
–...
• Shape:
– The shape of the erythrocytes can also affect
the ESR.
– Sickle cell retard ESR because abnormal cell
hamper ro...
Rouleaux formation
• When RBC aggregates to
form a rouleaux and settle
down the area is much less
than sum of the area of
...
Age
• Infant- low
• Adult- gradually increase
• Old- higher
sex
• Women has slightly higher
ESR then men because of
their low PCV.
Pregnancy
• The ESR begins to increase about third
the month and return to normal about
four week after delivery.
Temperature
• Test should be done at 20-25⁰ C
• Higher temperature cause false high
results due to reduction in plasma
vis...
Time
• Test should be done within two
hours of collection
• EDTA sample should be kept at
4°C if delayed but should be
per...
Anticoagulant
• K2EDTA or tri-sodium citrate should
be used
• Heparin alter cell membrane potential
and should not be used
Tube factor
• ESR is greater with longer tube
• Inner diameter should be 2.5mm or
more to overcome capillary
attraction
Position of tube
• Tube should be perfectly vertical
• ESR increase as the RBC slide down
along the lower side
• Angle of ...
Vibration
• Vibration can reduce ESR
Hemolysed or clotted sample
• It retard ESR
• Clot trap fibrinogen hence,
no rouleaux formation occur
Sunlight
• Direct sunlight on ESR tube increase ESR
Other factors
• Drugs such as dextran, methyldopa, oral
contraceptives, penicillamine procainamide,
theophylline, and vita...
General assumption
Clinical significance
Increased ESR
• Pregnancy
• Anemia
• Macrocytosis
• Inflammatory disease
• Acute and chronic infecti...
Methods of estimating ESR
• Wintrobe’s method
• Westergren method
• Modified Westergren method
• Automated method
Wintrobe’s method
Wintrobe tube:
• It is closed at one end
• length- 110 mm long
• Internal bore diameter 2.5mm.
• Tube is...
Requirement
Sample
• EDTA blood
Apparatus required
• Wintrobe tube
• Wintrobe stand
• ESR needle
• Timer
The procedure mus...
Procedure
• Mix the anti coagulated blood thoroughly.
• Fill the wintrobe tube by using Pasteur pipette
upto mark 0.
• Pla...
Normal range
• Male=0-10 mm in 1st hour
• Female=0-20 mm in 1st hour
Westergren method
• Simple and widely used method
• Method recommended by ICHS
Requirement
Sample
• Trisodium citrated
anticoagulated blood
• 1.6 ml of blood is mixed
with 0.4 ml of TSC
Apparatus
• Wes...
Westergren tube
• Length= 30cm
• Internal bore diameter= 2.5mm
• Can hold about 1ml of blood
• Open at both end
• Calibrat...
Procedure
• Mix the blood thoroughly.
• Draw blood into the tube up to mark ‘0’ with
the help of rubber bulb.
• Wipe out b...
Normal value
• Male= 0-5mm in 1st hour
• Female=0-7mm in 1st hour
Advantages
• More reliable and gives
accurate result
Disadvantages
• More blood is required
• Difficult to fill the blood ...
Modified Westergren Method
• EDTA blood is used instead of citrate.
• 2ml of EDTA blood is diluted with 0.5 ml
of 3.8% TSC...
Automated method
• Ves-Matic
• ESR STAT-PLUS
• SEDIMAT
• Zeta Sedimentation
VES-MATIC 20 instrument
• It is designed to measure 20 blood
sample.
• Result are comparable to Westergren
method
• result...
Blood is collected in a special cuvette
Sample is mixed by instrument
Sample is allowed to stand
at 18⁰ slant from vertica...
ESR STAT PLUS
• It is centrifugation based method.
• Provides results in 5 minutes.
Working principle:
Sample is placed in centrifuge
Infrared laser tracks the erythrocyte plasma interface and takes multipl...
SEDIMAT
• The filled Sediplast Westergren pipet is placed
into the SEDIMAT automated ESR reader,
which accelerates sedimen...
Zeta Sedimentation Ratio
• The ZSR is performed using a special, small-bore
capillary tube that is filled with blood and s...
Advantages of automated methods
• Save technician time
• Provide increased safety because the
need for sample manipulation...
Source of error
• Improper ratio of blood and
anticoagulant.
• Hemolysed sample.
• Clotted blood.
• Presence of air bubble...
Erythrocyte Sedimentation Rate
Erythrocyte Sedimentation Rate
Erythrocyte Sedimentation Rate
Erythrocyte Sedimentation Rate
Erythrocyte Sedimentation Rate
Upcoming SlideShare
Loading in …5
×
Upcoming SlideShare
Erythrocyte sedimentation rate (esr)
Next

238

Share

Erythrocyte Sedimentation Rate

Methods of estimating ESR

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

Erythrocyte Sedimentation Rate

  1. 1. Objectives • What is ESR? • Explain the principle of erythrocyte sedimentation. • Discuss mechanism of ESR? • What are the factors affecting ESR? • What are methods of estimating ESR? • What is the clinical significance of ESR? • What are the source of error while doing the test?
  2. 2. ESR • Erythrocyte- red cell • Sedimentation- settling • Rate- amount in a given time
  3. 3. Introduction • Also k/a ‘sed’ rate • Non specific test indicative of inflammation • It is used as an initial screening tool and also as a follow-up test to monitor therapy and progression or remission of disease. • Easy to perform, inexpensive • Inexpensive making it a widely used screening test.
  4. 4. • Inexpensive making it widely used screening test • Measure- how much red cell will settle in a given time • Unit-measured in mm/hrs Why is the ‘hr’ bit important?
  5. 5. Principle When the anti coagulated blood is allowed to stand vertically, the red cells will settle towards the bottom of the tube till they form a packed column in a given interval of time. The process of sediment6ation is called ESR.
  6. 6. Mechanism • ESR is determined by the interaction between factors that promote (fibrinogen) and resist (negative charge of RBCs - that repel each other) sedimentation. • Normal RBCs settle slowly as they do not form rouleaux. Instead, they gently repel each other due to the negative charge on their surfaces. • Rouleaux are stacks of many RBCs that become heavier and sediment faster.
  7. 7. Mechanism • Plasma proteins, especially fibrinogen, adhere to the red cell membranes and neutralize the surface negative charges, promoting cell adherence and rouleaux formation • The ESR is directly proportional to the weight of the cell aggregate and inversely proportional to the surface area
  8. 8. Stages • Stage of rouleaux formation/aggregation- 10 min • Stage of sedimentation/settling- 40 min • Stage of packing- 10min
  9. 9. Factors affecting ESR Physiological factors • Plasma factors • Red cell factors • Rouleaux formation • Age • Sex • Pregnancy laboratory factors • Temperature • Time • Anticoagulants • Tube factor • Tilting of tube • Vibration • Sunlight
  10. 10. Plasma factors • Fibrinogen, globulin and cholesterol increase ESR by decreasing negative charge of RBC. Negative charge prevent the RBC coming together • Plasma albumin retards sedimentation of RBCs. • Lecithin- retard ESR
  11. 11. Red cell factor • Number: – Increased in red cell mass- decrease ESR – Decreased red cell mass- increased in ESR • Size: – Microcyte sediment slowly and macrocyte sediment rapidly than normocyte
  12. 12. • Shape: – The shape of the erythrocytes can also affect the ESR. – Sickle cell retard ESR because abnormal cell hamper rouleaux formation – Spherocytic cells also sediment at a slow rate Red cell factor
  13. 13. Rouleaux formation • When RBC aggregates to form a rouleaux and settle down the area is much less than sum of the area of constituent corpuscle • Hence it is important factor that increase ESR
  14. 14. Age • Infant- low • Adult- gradually increase • Old- higher
  15. 15. sex • Women has slightly higher ESR then men because of their low PCV.
  16. 16. Pregnancy • The ESR begins to increase about third the month and return to normal about four week after delivery.
  17. 17. Temperature • Test should be done at 20-25⁰ C • Higher temperature cause false high results due to reduction in plasma viscosity • Always bring refrigerated blood at RT • Rise in every 3⁰ ESR increase by 1mm
  18. 18. Time • Test should be done within two hours of collection • EDTA sample should be kept at 4°C if delayed but should be performed within 6 hours.
  19. 19. Anticoagulant • K2EDTA or tri-sodium citrate should be used • Heparin alter cell membrane potential and should not be used
  20. 20. Tube factor • ESR is greater with longer tube • Inner diameter should be 2.5mm or more to overcome capillary attraction
  21. 21. Position of tube • Tube should be perfectly vertical • ESR increase as the RBC slide down along the lower side • Angle of 3⁰ from vertical can increase ESR by 30℅
  22. 22. Vibration • Vibration can reduce ESR
  23. 23. Hemolysed or clotted sample • It retard ESR • Clot trap fibrinogen hence, no rouleaux formation occur
  24. 24. Sunlight • Direct sunlight on ESR tube increase ESR
  25. 25. Other factors • Drugs such as dextran, methyldopa, oral contraceptives, penicillamine procainamide, theophylline, and vitamin A can increase ESR, while aspirin, cortisone, and quinine may decrease it.
  26. 26. General assumption
  27. 27. Clinical significance Increased ESR • Pregnancy • Anemia • Macrocytosis • Inflammatory disease • Acute and chronic infection • Multiple myeloma • Rheumatic fever • Rheumatoid arthritis • Anemia • Tuberculosis • Systemic lupus erythematosus Decreased ESR • Hyperviscosity • Decreased fibrinogen levels • Polycythemia • Sickle cell anemia • Spherocytosis • Microcytosis
  28. 28. Methods of estimating ESR • Wintrobe’s method • Westergren method • Modified Westergren method • Automated method
  29. 29. Wintrobe’s method Wintrobe tube: • It is closed at one end • length- 110 mm long • Internal bore diameter 2.5mm. • Tube is calibrated on both sides: 0-10 and 10-0.
  30. 30. Requirement Sample • EDTA blood Apparatus required • Wintrobe tube • Wintrobe stand • ESR needle • Timer The procedure must be performed within 2 hours of blood collection.
  31. 31. Procedure • Mix the anti coagulated blood thoroughly. • Fill the wintrobe tube by using Pasteur pipette upto mark 0. • Place the tube vertically in a stand. • Note the ESR at the end of 1 hour.
  32. 32. Normal range • Male=0-10 mm in 1st hour • Female=0-20 mm in 1st hour
  33. 33. Westergren method • Simple and widely used method • Method recommended by ICHS
  34. 34. Requirement Sample • Trisodium citrated anticoagulated blood • 1.6 ml of blood is mixed with 0.4 ml of TSC Apparatus • Westergren tube • Westergren stand • Rubber bulb • Timer
  35. 35. Westergren tube • Length= 30cm • Internal bore diameter= 2.5mm • Can hold about 1ml of blood • Open at both end • Calibrated from top to bottom: 0-200mm
  36. 36. Procedure • Mix the blood thoroughly. • Draw blood into the tube up to mark ‘0’ with the help of rubber bulb. • Wipe out blood from bottom of the tube. • Transfer the tube to westergren stand and stand it vertically. • Record the time and take reading.
  37. 37. Normal value • Male= 0-5mm in 1st hour • Female=0-7mm in 1st hour
  38. 38. Advantages • More reliable and gives accurate result Disadvantages • More blood is required • Difficult to fill the blood in tube • PCV cannot be done • Mouth pipetting may be hazardous
  39. 39. Modified Westergren Method • EDTA blood is used instead of citrate. • 2ml of EDTA blood is diluted with 0.5 ml of 3.8% TSC or 0.85% NaCl • Undiluted blood gives poor precision.
  40. 40. Automated method • Ves-Matic • ESR STAT-PLUS • SEDIMAT • Zeta Sedimentation
  41. 41. VES-MATIC 20 instrument • It is designed to measure 20 blood sample. • Result are comparable to Westergren method • results are available in approximately 22 minutes.
  42. 42. Blood is collected in a special cuvette Sample is mixed by instrument Sample is allowed to stand at 18⁰ slant from vertical Opto-electrical sensor measure ESR Data are elaborated and printed Working principle:
  43. 43. ESR STAT PLUS • It is centrifugation based method. • Provides results in 5 minutes.
  44. 44. Working principle: Sample is placed in centrifuge Infrared laser tracks the erythrocyte plasma interface and takes multiple measurements Linear portion of sedimentation is identified Software algorithm to determine ESR result
  45. 45. SEDIMAT • The filled Sediplast Westergren pipet is placed into the SEDIMAT automated ESR reader, which accelerates sedimentation under controlled conditions. • The reader displays the results of each sample on an LCD display after 15 minutes. • The results are also stored in memory and can be printed out.
  46. 46. Zeta Sedimentation Ratio • The ZSR is performed using a special, small-bore capillary tube that is filled with blood and spun for 3 to 4 minutes in a special centrifuge called the Zetafuge • Centrifuge alternately compacts and disperses the RBCs under standardized centrifugal force • Tube is then read on a special reader to obtain a value called the zetacrit • It is rapid, corrects for anemia, and requires only a small blood sample, which is desirable for pediatric patients
  47. 47. Advantages of automated methods • Save technician time • Provide increased safety because the need for sample manipulation is decreased • Interface with laboratory information systems (LIS) • Use smaller sample volumes • Provide more rapid results
  48. 48. Source of error • Improper ratio of blood and anticoagulant. • Hemolysed sample. • Clotted blood. • Presence of air bubbles. • Error due to sunlight, vibration, small bore size, dirty and wet tube. • Delay in performing the test.
  • ElviskiptooLongura

    Aug. 19, 2021
  • DavidOlajideOmole

    Jul. 31, 2021
  • DavidOlajideOmole

    Jul. 31, 2021
  • PremKumar1014

    Jul. 8, 2021
  • RaviranjanKashyap

    Jul. 6, 2021
  • HassanTariqTariqHussian

    Jul. 2, 2021
  • MahzaibAwan

    Jun. 18, 2021
  • afreenfatima46

    Jun. 17, 2021
  • AmberSohaib

    Jun. 16, 2021
  • DevikaSajayan

    Jun. 15, 2021
  • ssuser9575dd

    May. 22, 2021
  • PrasannaPriyalatha1

    May. 18, 2021
  • HoseinKamrani

    May. 7, 2021
  • UrvashiSharma48

    Apr. 16, 2021
  • ZainabBadamasi

    Apr. 13, 2021
  • SarruFathima

    Apr. 7, 2021
  • FaithKarimi3

    Mar. 31, 2021
  • nishisharma1654

    Mar. 30, 2021
  • AbdallaElnour2

    Mar. 19, 2021
  • mursalinvakil

    Mar. 18, 2021

Methods of estimating ESR

Views

Total views

75,260

On Slideshare

0

From embeds

0

Number of embeds

65

Actions

Downloads

0

Shares

0

Comments

0

Likes

238

×